Major Medical Research Articles

Patient and public involvement in preclinical and medical research: Evaluation of an established programme in a Discovery-Based Medical Research Institute.

Involving people with lived experience of health conditions and the public (consumers) in health research is supported by policy, practice and research funding schemes. However, consumer involvement programmes in discovery-based preclinical research settings are uncommon. Few formal evaluations of these programmes are reported in the literature. This study aimed to evaluate an established patient and public involvement programme operating in a major Australian Discovery-Based Medical Research Institute (DBMRI) to inform programme development and the wider field. A multimethods programme evaluation incorporating demographic, descriptive and qualitative data obtained through consumer/researcher co-developed online surveys and semistructured virtual interviews. Programme participants (n = 111) were invited to complete an online survey seeking feedback on their experience of involvement, programme processes and perceived impacts. A purposive sample of 25 participants was interviewed. Descriptive data were analysed using explanatory statistics and qualitative data from surveys and interviews were thematically analysed. This consumer involvement programme was found to be useful and meaningful for most participants, with specific examples of perceived added value. Consumers most commonly engaged with researchers to inform research development, prepare funding applications or strengthen lay communication of science. Genuine consumer-researcher interactions, relationship development and mutual respect were key elements in a positive experience for participants. Opportunities to 'give back', to learn and to ground research in lived experience were identified programme strengths and benefits. Developing researcher training in how to work with consumers, increasing the diversity of the consumer group membership and expanding the range of consumer activities were identified opportunities for improvement. Organisational support and adequate programme resourcing were identified as key enablers. Discovery-based preclinical research is often viewed as being distant from clinical application; therefore, consumer involvement may be considered less relevant. However this study identified value in bringing a strong consumer voice to the discovery-based research process through a coordinated, organisation-wide approach with the potential for application in similar preclinical research settings. Four consumer partners from the DBMRI Consumer Advisory Panel were actively engaged in developing this programme evaluation. Specifically, these consumer partners co-developed and pilot-tested surveys and interview guides, reviewed and commented on project data analysis and reporting and also contributed as co-authors by editing the manuscript.

Changes to the Major Trauma Pre-Hospital Emergency Medical System Network before and during the 2019 COVID-19 Pandemic.

During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49-0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73-1.30; p = 0.325). The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.

Level of Anxiety among Undergraduate Students of Major Public Sector Dental and Medical Colleges, Peshawar

Level of Anxiety among Undergraduate Students of Major Public Sector Dental and Medical Colleges, Peshawar

Research trends in hypertension associated with obstructive sleep apnea: a bibliometric analysis.

The purpose of this study was to systematically analyze the studies of hypertension associated with obstructive sleep apnea to assess the current status and hot spots in this field. We searched the Web of Science Core Collection for publications related to hypertension associated with obstructive sleep apnea published before July 3, 2021. Bibliometric analyses and science mappings were carried out using the CiteSpace 5.8.R1 and Microsoft Office Excel 2019. CiteSpace 5.8.R1 was used to visualize the distribution of research fields, analyze co-occurring keywords and burst terms to detect trends and frontiers, and identify leading collaborations among countries, authors, and institutions. Microsoft Office Excel 2019 was used to make bar graphs, histograms and line graphs. According to the search strategy, a total of 7263 published articles and reviews were retrieved. The research on hypertension associated with obstructive sleep apnea has been developing quickly at present. Sleep and Breathing was the most productive journal. TheUSA was a major producing country and Harvard Medical School was the most productive institution in this field. In the field of hypertension associated with obstructive sleep apnea, the main research hotspots were continuous positive airway pressure, cardiovascular disease, andobesity. The present study provides a new perspective for the study of hypertension associated with obstructive sleep apnea and valuable information for researchers to find potential partners and cooperative institutions, hot issues and research frontiers.

Holding Them Accountable: Organizational Commitments to Ending Systemic Anti-Black Racism in Medicine and Public Health.

In this essay, I detail commitments that some of the major health organizations-the American Medical Association, the American Public Health Association, and the Centers for Disease Control and Prevention-have made to addressing anti-Black racism and discuss their policies meant to curtail racism's effects on health equity. Although these organizations' historical lack of action has contributed to a culture of anti-Black racism in health care and public health and many Black people have suffered because of it, progress has to begin somewhere, and outlining their future actions is a good start. Now, bioethicists, with our expertise in how historic policies connect to contemporary disparate health outcomes and access to health care, are in a position to hold these organizations accountable for fulfilling their commitments.

Ursodeoxycholic Acid and SMOFlipid for Treating Parenteral Nutrition Associated Cholestasis in Infants.

Background: Parenteral nutrition-associated cholestasis (PNAC) is frequently seen in preterm infants receiving total parenteral nutrition (TPN) for a long duration. The pathogenesis of PNAC is believed to be multifactorial; however, phytosterols are hepatotoxic, resulting in cholestasis. A novel lipid emulsion consisting of a mixture of soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOFlipid) with a low level of phytosterols has been shown to improve cholestasis. Moreover, ursodeoxycholic acid (UDCA) has improved bile flow and normalized liver function tests. This study aimed to determine the effect of UDCA and SMOFlipid in preventing and treating PNAC in infants.Methods: We conducted a retrospective cohort study that included all infants who received TPN for at least five days between January 2010 and December 2018, who also received UDCA for the treatment of cholestasis, and infants who developed cholestasis but were not treated with UDCA. In addition, any infants who received SMOFlipid for parenteral nutrition during the same period were included. We recorded multiple variables, including neonatal demographic data, major medical diagnosis, liver function, medications, and maternal variables.Results: A total of 58 infants with cholestasis who received UDCA for treatment were identified. The infants were divided into two groups, Group 1 infants had gestational age (GA) of ≤32 weeks, and Group 2 had GA of >32 weeks. We found that combining SMOFlipid with UDCA resulted in a significant reduction in cholestasis duration in both groups. Infants in Group 1 who received SMOFlipid had cholestasis for a mean of 67 ± 57 days, and those who did not receive SMOFlipid had cholestasis for a mean of 145 ± 102 days (p=0.04). Infants in Group 2 who received SMOFlipid had cholestasis for a mean of 38.2 ± 28 days, and those who did not receive SMOFlipid had cholestasis for a mean of 117 ± 119 days (p=0.02).Conclusions: According to our results, the use of UDCA and SMOFlipid reduced the duration of parenteral nutrition-associated with cholestasis in very low birth weight infants.

<b>ToPP:</b> <b>T</b>umor <b>o</b>nline <b>P</b>rognostic Analysis <b>P</b>latform for Prognostic Feature Selection and Clinical Patient Subgroup Selection

Tumor heterogeneity among different patients result in different response to anti-cancer therapeutics and survival. To identify features that are associated with prognosis is essential to precision medicine by providing clues for target identification, drug discovery. Here, we developed a Tumor online Prognostic analysis Platform (ToPP) to explore the prognosis associated genetic features in multi-omic levels in different tumor types. The ToPP platform integrated eight multi-omics features and clinical data for 55 tumor types. It provides multiple ways for customized prognostic studies, including 1) Prognostic analysis based on multi-omics features such as genetic variation (mutation, CNV, methylation) and clinical characteristics; 2) Automatic construction of prognostic model with variable selection, transformation and model evaluation for both public data and custom data; 3) Pancancer prognostic analysis in multi-omics data based on tumor related pathways; 4) Explore the impact of different levels of feature combinations on patient prognosis; 5) More sophisticated prognostic analysis according to regulatory network such as miRNA-gene regulation relationship, gene mutation-expression relationship; 6) Prognostic study of custom data and comparison with public datasets. ToPP provides a comprehensive source and easy-to-use interface for tumor prognosis research, with one-stop service of multi-omics, subtype and online prognostic modeling. The web-server is freely available at http://www.biostatistics.online/topp/index.php. Funding: This work was supported by Shanghai Municipal Health Commission and Collaborative Innovation Cluster Project (No. 2019CXJQ02). It was also supported by National Natural Science Foundation of China grants (Nos. 31878209, 31671377), Shanghai Municipal Science and Technology Major Project (Grant No. 2017SHZDZX01, 20692191500), Beihang University & Capital Medical University Plan (BHME-201904) and the Open Research Fund of Key Laboratory of Advanced Theory and Application in Statistics and Data Science-MOE, ECNU. Declaration of Interest: The authors declare that they have no competing interests.

How Does The AJCC/TNM Staging System Eighth Edition Perform in Thyroid Cancer at A Major Middle Eastern Medical Center?

ObjectiveThe American Joint Committee on Cancer tumor node metastasis (TNM) staging system eighth edition (TNM-8) for differentiated thyroid cancer (DTC) has been introduced as a replacement for tumor node metastasis staging system seventh edition (TNM-7). We present the first study from a Middle Eastern population comparing these 2 versions of the TNM staging system. MethodsWe compared TNM-8 with TNM-7 in 701 patients with DTC seen during a 3-year period with a median age of 37 years (6-83) and a female-to-male ratio of 558 (79.6%) to 143 (20.4%). ResultsThe number (%) of patients within each stage in TNM-7 and TNM-8, respectively, are as follows: stage I = 503 (71.6%) and 583 (83.2%), stage II = 52 (7.4%) and 81 (11.4%), stage III = 53 (7.6%) and 6 (0.9%), and stage IV = 93 (13.2%) and 31 (4.6%). Overall, 172 patients (24.5%) were downstaged in TNM-8 compared to that in TNM-7, as follows: 26, 30, and 24 patients from stages II, III, and IV in TNM-7 to stage I in TNM-8; 23 and 32 patients from TNM-7 stages III and IV to TNM-8 stage II; 6 patients from stage IVa in TNM-7 to stage III in TNM-8; and 31 patients from stage IVc in TNM-7 to stage IVb in TNM-8. TNM-7 and TNM-8 predicted the long-term outcome well (median follow-up, 7.9 years), but Kaplan-Meier analysis showed better separation of cancer-specific survival in TNM-8 compared to TNM-7. ConclusionsCompared with TNM-7, TNM-8 approximately downstaged a quarter of DTC patients and was more robust in separating the outcome of different stages over time.

Severe COVID-19 Illness: Risk Factors and Its Burden on Critical Care Resources.

In South Korea, the first confirmed case of coronavirus 2019 (COVID-19) was detected on January 20, 2020. After a month, the number of confirmed cases surged, as community transmission occurred. The local hospitals experienced severe shortages in medical resources such as mechanical ventilators and extracorporeal membrane oxygenation (ECMO) equipment. With the medical claims data of 7,590 COVID-19 confirmed patients, this study examined how the demand for major medical resources and medications changed during the outbreak and subsequent stabilization period of COVID-19 in South Korea. We also aimed to investigate how the underlying diseases and demographic factors affect disease severity. Our findings revealed that the risk of being treated with a mechanical ventilator or ECMO (critical condition) was almost twice as high in men, and a previous history of hypertension, diabetes, and psychiatric diseases increased the risk for progressing to critical condition [Odds Ratio (95% CI), 1.60 (1.14–2.24); 1.55 (1.55–2.06); 1.73 (1.25–2.39), respectively]. Although chronic pulmonary disease did not significantly increase the risk for severity of the illness, patients with a Charlson comorbidity index score of ≥5 and those treated in an outbreak area had an increased risk of developing a critical condition [3.82 (3.82–8.15); 1.59 (1.20–2.09), respectively]. Our results may help clinicians predict the demand for medical resources during the spread of COVID-19 infection and identify patients who are likely to develop severe disease.

MON-520 How Does the American Joint Committee on Cancer 8thEdition Tumor, Node, Metastasis Staging System Perform in Patients Evaluated at a Major Middle Eastern Medical Center?

The American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) Classification of Cancer 8th edition (AJCC8) was officially introduced in January 2018 as a replacement for the previous version (AJCC7). Validation studies using data obtained from large cancer registries in North America demonstrated the superiority of AJCC8 over AJCC7 for prediction of survival. Subsequent studies from Europe and East Asia have mostly shown similar findings. However, these data may not be generalizable to other parts of the world. In this first study from the Middle East (Saudi Arabia), we compared these two versions of AJCC staging for their concordance and prediction of outcome in a large unselected sample of patients (pts) with DTC managed at a major referral medical center. We also compared the AJCC staging systems with the American Thyroid Association (ATA) Risk Classification.Of 814 consecutive pts seen during this period, 94 were excluded either due to their diagnosis being medullary or anaplastic thyroid cancer (37) or because of deficient data. The remaining 720 pts (149 males (20.7%), 571 females (79.3%) were included. The median age at the diagnosis was 37 yrs (range, 6-83). Total thyroidectomy was performed in 693 pts (96.3%) and central and/or lateral lymph node dissections in 487 pts (67.6%). I-131 was administered to 626 pts (87%). The tumors were classic PTC in 519 pts (72%), follicular variant PTC in 100 (13.9%), Tall cell PTC in 22 (3.1%), diffuse sclerosing PTC in 10 (1.4%), follicular thyroid cancer in 21 (2.9%) and other rare subtypes in 48 pts (6.8%).The number (%) of pts within each stage group by AJCC7 and AJCC8 respectively are as follows: Stage 1: 514 (71.4%) vs. 597 (82.9%), Stage 2: 46 (6.4%) vs. 75 (10.4%), Stage 3: 63 (8.8%) vs. 11 (1.5%), Stage 4: 97 (13.5%) vs. 37 (5.1%).Comparing AJCC8 with the ATA risk stratification system in 709 pts in which data were available, we found a high correlation with 96.8% of ATA low risk group being stage 1 in AJCC8, 2.9% stage 2 and 0.3% stage 3 and none in stage 4. The ATA intermediate risk group was 87.4% AJCC8 stage 1, 12.3% stage 2, 0.4% stage 3 and none in stage 4. The ATA high risk group was 19.1% in AJCC8 stage 1, 33% in stage 2, 9.6% in stage 3 and 38.3% in stage 4.In addition, AJCC8 was more predictive of the outcome with 80% of pts with evidence of disease (biochemically and structurally incomplete) being in AJCC8 stage 3 or 4 compared with 60% in AJCC7. For ATA staging, 8.6%, 22.4% and 67.7% of low, intermediate and high risk groups had evidence of disease at the last follow up, respectively.Conclusion: In this Middle Eastern population, AJCC8 downstaged a significant percentage of pts with DTC from higher stages in AJCC7. It also correlated better with the outcome and with the ATA risk classification system.

Expression of programmed death receptor-1 and its prediction of postoperative infectious complications in elderly patients with hip fracture

Objective To investigate the expression of programmed death receptor-1 (PD-1) and its value in predicting the infectious complications in elderly patients with hip fracture. Methods A total of 119 elderly patients with intertrochanteric fracture(observation group) were prospectively enrolled for this study from August 2015 to August 2016 at Department of Orthopaedics, The Seventh Medical Center of PLA. They were 86 males and 33 females with an age of 80.7±8.1 years. Another 20 elderly out-patients with gonarthritis but without trauma or major medical disease were enrolled as a control group. The observation group received closed reduction and internal fixation with proximal femoral intramedullary nails. The PD-1 expression in peripheral blood T cells was detected at preoperation, 1, 3 and 5 days postoperation in the patients of observation group. They were further divided into an infection group and a non-infection group depending on whether infectious complications occurred during the follow-up period. The association between PD-1 and infectious complications was analyzed and its predictive value was calculated. Results The observation group and the control group, as well as the infection group and the non-infection group, were compatible due to their insignificant differences in baseline data(P>0.05).Compared with the control group, the expression of PD-1 in the peripheral blood T cells in the observation group was all significantly increased at preoperation, 1, 3 and 5 days postoperation (P<0.05). The PD-1 expression in patients of the infection group (24 cases) increased significantly higher at 1, 3 and 5 days postoperation (33.60%±2.44%, 35.68%±4.05% and 30.36%±4.42%) than in those of the non-infection group (29.57%±3.20%, 21.45%±2.20% and 20.94%±2.30%) (P<0.05). The PD-1 expression in the infection group reached its peak at 3 days postoperation and did not fall to the preoperative level at 5 days postoperation. However, the PD-1 expression in patients of the non-infection group (95 cases) showed a transient rise only on the first day postoperation. The cutoff value of the difference in PD-1 expression between 1 and 3 days postoperation that could predict the infectious complications was 3.4%, with a sensitivity of 95.6% and a specificity of 92.6%. Conclusions The expression of PD-1 may significantly increase after intramedullary fixation of hip fracture in elderly patients. The patients with infectious complications may exhibit a greater and longer increase in PD-1 expression than those without infectious complications. The difference in PD-1 expression between 1 and 3 days postoperation has a good predictive value for infectious complications because its high sensitivity and specificity. Key words: Hip fractures; Infections; Complications; Programmed death receptor-1

Lawsuits and Rulings

Free Speech: Dean Didn't Punish Union Organizer Disability: Suit Dismissed for Failure to Allege Major Life Activity Limitations Family and Medical Leave Act: Judge Rules in Favor of University

Systematic Review and Meta-Analysis of Computer Based Simulation Training for Non-Technical Skills Training and Knowledge in Postgraduate Medical Education

Introduction: The increase in simulation training across the range of medical education offers a potential route to train non-technical skills and knowledge. More recently, there has been a move towards the use of computer based, including virtual reality, simulation. However, studies evaluating the efficacy of computer based simulation training have used inconsistent methodology, limiting the capacity to construct an overview. The goal of this study is to systematically review the existing literature and carry out a meta-analysis of the existing randomised controlled trials, evaluating the efficacy of computer based simulation on non-technical skills and knowledge, with sub analysis between doctors in training and those in continuing medical education. Methods: A scoping search identified the relevant search terms, followed by a comprehensive database search of literature from 2007 until the present on MEDLINE, PubMed, CINHAL, ERIC, BEI, PsychINFO, Proquest Dissertations & Theses and Educational Abstracts databases with hand searching the table of contents of major medical education journals. The inclusion criteria were randomised controlled trials for the meta-analysis and cohort studies for the systematic review, with subjects being postgraduate doctors using a computer based simulation for training and education. Results: This review found evidence to support the utilisation of computer based simulation for nontechnical skills and knowledge and understanding domains. Discussion: Using computer based simulation offers an opportunity to enhance non-technical aspects of practicing doctors in a safe and effective manner. More high quality controlled studies are required to enable the demarcation of training boundaries. Keywords: NON-TECHNICAL SKILLS; SIMULATION-BASED TRAINING; SIMULATION- BASED MEDICAL EDUCATION; TECHNOLOGY ENHANCED LEARNING

Research progress in cancer pain

Cancer pain (CP) is a major medical problem, which causes physical and psychological pain to patients, reduces their quality of life and increases economic burden of the society. The paper reviews the recent progress in CP, mechanisms and treatment. Key words: Cancer pain; Treatment

EVOLUTION OF THE HOSPITALISATION EPISODES IN ADULTS WITH CANCER AGED 18+, IN PUBLIC ROMANIAN HOSPITALS BETWEEN 2013-2017

Malignant tumors are the main challenge of modern society through the major medical and socio-economic impact. In Romania, cancer is a major problem of the medical system and of society as a whole, a problem that is becoming more and more important with the increase in the number of cases, their complexity, the lack of financial resources for early detection and treatment of cases, especially in the current context in which patients present themselves to a physician and are diagnosed in advanced stages of illness. This study provides descriptive evidence at national, regional and local level on the geographical distribution of hospitalization episodes due to the main classes/categories of neoplasms, as well as the temporal evolution of their number in the period 2013-2017. We consider that a more in-depth analysis is needed to implement effective public health measures not only to improve the health of the population but also to improve the health services provided to patients according to their needs and to reduce the burden of the disease neoplastic on the health system and the national economy. Key words: malignant tumors, hospitals, Romania, descriptive evidence

Evaluating the cascading impacts of sea level rise and coastal flooding on emergency response spatial accessibility in Lower Manhattan, New York City

This paper describes a scenario-based approach for evaluating the cascading impacts of sea level rise (SLR) and coastal flooding on emergency responses. The analysis is applied to Lower Manhattan, New York City, considering FEMA’s 100- and 500-year flood scenarios and New York City Panel on Climate Change (NPCC2)’s high-end SLR projections for the 2050s and 2080s, using the current situation as the baseline scenario. Service areas for different response timeframes (3-, 5- and 8-min) and various traffic conditions are simulated for three major emergency responders (i.e. New York Police Department (NYPD), Fire Department, New York (FDNY) and Emergency Medical Service (EMS)) under normal and flood scenarios. The modelling suggests that coastal flooding together with SLR could result in proportionate but non-linear impacts on emergency services at the city scale, and the performance of operational responses is largely determined by the positioning of emergency facilities and the functioning of traffic networks. Overall, emergency service accessibility to the city is primarily determined by traffic flow speed. However, the situation is expected to be further aggravated during coastal flooding, with is set to increase in frequency and magnitude due to SLR.

Bulletin from the Opioid Crisis

In the past month alone (July/August 2017), almost a dozen articles and commentaries on the opioid crisis have appeared in major medical journals, with

Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial

Chronic low back pain (cLBP) is prevalent, especially among military veterans. Many cLBP treatment options have limited benefits and are accompanied by side effects. Major efforts to reduce opioid use and embrace nonpharmacological pain treatments have resulted. Research with community cLBP patients indicates that yoga can improve health outcomes and has few side effects. The benefits of yoga among military veterans were examined. Participants were randomized to either yoga or delayed yoga treatment in 2013-2015. Outcomes were assessed at baseline, 6 weeks, 12 weeks, and 6 months. Intention-to-treat analyses occurred in 2016. One hundred and fifty military veterans with cLBP were recruited from a major Veterans Affairs Medical Center in California. Yoga classes (with home practice) were led by a certified instructor twice weekly for 12 weeks, and consisted primarily of physical postures, movement, and breathing techniques. The primary outcome was Roland-Morris Disability Questionnaire scores after 12 weeks. Pain intensity was identified as an important secondary outcome. Participant characteristics were mean age 53 years, 26% were female, 35% were unemployed or disabled, and mean back pain duration was 15 years. Improvements in Roland-Morris Disability Questionnaire scores did not differ between the two groups at 12 weeks, but yoga participants had greater reductions in Roland-Morris Disability Questionnaire scores than delayed treatment participants at 6 months -2.48 (95% CI= -4.08, -0.87). Yoga participants improved more on pain intensity at 12 weeks and at 6 months. Opioid medication use declined among all participants, but group differences were not found. Yoga improved health outcomes among veterans despite evidence they had fewer resources, worse health, and more challenges attending yoga sessions than community samples studied previously. The magnitude of pain intensity decline was small, but occurred in the context of reduced opioid use. The findings support wider implementation of yoga programs for veterans. This study is registered at www.clinicaltrials.gov NCT02524158.

Recurrent Urinary Tract Infection in an Elderly Man

An elderly man with newly diagnosed dilated cardiomyopathy and benign prostatic hypertrophy presented with classical symptoms of complicated urinary tract infection (UTI) in a recurrent manner. A simple investigation, the plain abdominal X-ray, was overlooked and the diagnoses of staghorn stones and bladder stones were not made effectively. The outcome of UTI in men, which is often complicated, can be devastating. Surgical intervention can treat the root cause of recurrent UTI; however, in this gentleman with major medical comorbidity, limited options are available. J Med Cases. 2016;7(10):445-447 doi: http://dx.doi.org/10.14740/jmc2610w

Diagnosis and treatment of gastrointestinal neuroendocrine neoplasm in the multidisciplinary team model

Neuroendocrine neoplasm (NENs) is a kind of rare tumor which occurs in multiple human organs. The prognosis of NENs is relatively good, but the diagnosis and treatment of NENs is complicated and involve different specialties. In major medical centers, comprehensive and standard diagnosis and treatment could improve the prognosis of NENs and reduce the waiting and treatment time via multidisciplinary team (MDT) model. The regional variation and differences in the techniques among hospitals are decreasing through communication and learning among the members of MDT. Recently, the excellent MDT is working in a spirit of cooperation and sharing to create the patients-centered model, with professional doctors and complete hardware facilities. The NENs clinical center needs to strengthen diagnosis, treatment, research and training. Key words: Neuroendocrine neoplasms; Digestive system; Multidisciplinary Team